Petru, Michael

Petru, Michael is an individual health care provider with primary practice located at 6810 State Route 162 Suite 215, Maryville IL 62062-8501. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Petru, Michael can be contacted via phone (618) 288-5711.

Contact Information

Primary practice address
6810 State Route 162 Suite 215 Maryville IL 62062-8501
Phone: (618) 288-5711
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X Illinois

Profile Details

NPI number 1124188354
LBN Legal business name Petru, Michael
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 11th, 2006
Last updated Feb 19th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1124188354 NPPES
Illinois MEDICAID 340628294001

Popular Providers